Medical Staff Credentialing Verification Checklist
Comprehensive medical staff credentialing verification including primary source verification, background checks, and competency assessment.
- Industry: Healthcare
- Frequency: Initial/Reappointment
- Estimated Time: Several hours
- Role: Medical Staff Services
- Total Items: 32
- Compliance: Joint Commission MS Standards, CMS CoP, NCQA Credentialing
Primary Source Verification
Required verifications
- Medical school verified?
- Residency training verified?
- Current medical license verified?
- DEA certificate verified?
- Board certification verified?
Background Checks
Required checks
- NPDB query completed?
- OIG exclusion list checked?
- SAM exclusion list checked?
- Malpractice history verified?
Competency Assessment
Competency verification
- Peer references obtained?
- Privileges appropriate for training?
- Current competence verified?
Work History
Employment verification
- Work history verified (5 years)?
- Gaps in history explained?
Pre-Assessment Information
Initial assessment documentation and patient/facility identification
- Assessor Name / Credentials
- Assessment Date
- Department / Unit
- Assessment Type (Routine/Annual/Complaint)
- Previous assessment findings reviewed?
Infection Prevention & Control
Verify infection control practices per CDC and Joint Commission standards
- Hand hygiene compliance observed?
- Appropriate PPE available and properly used?
- Isolation precautions properly implemented?
- Sharps containers available and not overfilled?
- High-touch surfaces properly disinfected?
Patient Safety & Identification
Verify patient safety protocols and identification procedures
- Two patient identifiers used before procedures?
- Fall risk assessment completed?
- Call light within patient reach?
- Bed in lowest position with brakes locked?
Medication Safety & Management
Verify medication handling and administration practices
- Medications stored securely and at proper temperature?
- Controlled substances properly secured and counted?
- No expired medications in stock?
- High-alert medications properly labeled?
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Why Use This Medical Staff Credentialing Verification Checklist?
This medical staff credentialing verification checklist helps healthcare teams maintain compliance and operational excellence. Designed for medical staff services professionals, this checklist covers 32 critical inspection points across 8 sections. Recommended frequency: initial/reappointment.
Ensures compliance with Joint Commission MS Standards, CMS CoP, NCQA Credentialing. Regulatory-aligned for audit readiness and inspection documentation.
Frequently Asked Questions
What does the Medical Staff Credentialing Verification Checklist cover?
This checklist covers 32 inspection items across 8 sections: Primary Source Verification, Background Checks, Competency Assessment, Work History, Pre-Assessment Information, Infection Prevention & Control, Patient Safety & Identification, Medication Safety & Management. It is designed for healthcare operations and compliance.
How often should this checklist be completed?
This checklist should be completed initial/reappointment. Each completion takes approximately Several hours.
Who should use this Medical Staff Credentialing Verification Checklist?
This checklist is designed for Medical Staff Services professionals in the healthcare industry. It can be used for self-assessments, team audits, and regulatory compliance documentation.
Can I download this checklist as a PDF?
Yes, this checklist is available as a free PDF download. You can also use it digitally in the POPProbe mobile app for real-time data capture, photo documentation, and automatic reporting.